tbuckley/cabot-search huggingface dataset:
Plan Selection, Enrollee Risk, and Health Spending on the Patient Protection and Affordable Care Act Individual Marketplaces, 2019
Authors: Graham Treasure, David M. Anderson, Lauren Hatcher, Alexandra E. Makhoul, Darren Johnson, Jenna Stefan, Kevin N. Griffith
Journal: JAMA Network Open (2023)

The Patient Protection and Affordable Care Act (ACA) individual marketplaces are a source of insurance for millions of residents in the US. However, the association between enrollee risk, health spending, and metal tier selection remains unclear.To describe individual marketplace enrollees' metal tier selections by risk score and assess enrollees' health spending by metal tier, risk score, and spending type.This retrospective, cross-sectional study analyzed claims data from the Wakely Consulting Group ACA database, a deidentified claims database built on data voluntarily submitted by insurers. Enrollees with continuous, full-year enrollment in on-exchange or off-exchange ACA-qualified health plans during the 2019 contract year were included. Data analysis was conducted from March 2021 to January 2023.Enrollment totals, total spending, and out-of-pocket cost were calculated, stratified by metal tier and the Department of Health and Human Services (HHS) Hierarchical Condition Category (HCC) risk score for 2019.Enrollment and claims data were obtained for 1 317 707 enrollees (53.5% female; mean [SD] age, 46.35 [13.43] years) across all census areas, age groups, and sexes. Of these, 34.6% were on plans with cost-sharing reductions (CSRs), 75.5% did not have an assigned HCC, and 84.0% submitted at least 1 claim. Compared with enrollees in bronze plans (17.2%), enrollees were more likely to be classified in the top HHS-HCC risk quartile if they selected platinum (42.0%), gold (34.4%), or silver (29.7%) plans. The highest share of enrollees with $0 total spending was noted with the catastrophic (26.4%) and bronze (22.7%) plans, while gold plans had the lowest share (8.1%). Median total spending was lower among bronze plan enrollees ($593; IQR, $28-$2100) vs platinum ($4111; IQR, $992-$15 821) or gold ($2675; IQR, $728-$9070). Within the top risk score decile, CSR enrollees had less average total spending than any other metal tier by more than 10%.In this cross-sectional study of the ACA individual marketplace, enrollees who selected plans with higher actuarial value also had greater mean HHS-HCC risk scores and health spending. The findings suggest these differences may be associated with variation in benefit generosity by metal tier, enrollee's perceptions of future health needs, or other barriers to care access.
Incidence of Precipitated Withdrawal During a Multisite Emergency Department–Initiated Buprenorphine Clinical Trial in the Era of Fentanyl
Authors: Gail D’Onofrio, Kathryn F. Hawk, Jeanmarie Perrone, Sharon L. Walsh, Michelle R. Lofwall, David A. Fiellin, Andrew Herring
Journal: JAMA Network Open (2023)

This cohort study examines the incidence of precipitated withdrawal comparing traditional sublingual buprenorphine with a 7-day extended-release injectable initiated in the emergency department (ED).
Association of Nonconcussive Repetitive Head Impacts and Intense Physical Activity With Levels of Phosphorylated Tau<sub>181</sub> and Total Tau in Plasma of Young Elite Soccer Players
Authors: Martin Cente, Janka Perackova, Pavol Peracek, Marek Majdan, Igor Toth, Martin Mikulic, Jozef Hanes, Sara Porubska, Marian Spajdel, Barbora Kazickova, Igor Jurisica, Peter Filipcik
Journal: JAMA Network Open (2023)

Importance Head impacts resulting in traumatic brain injury (TBI) lead to the elevation of phosphorylated tau protein (p-tau 181 ) in plasma. To our knowledge, this study is the first to investigate dynamics of p-tau 181 levels and the ratio of p-tau 181 to total tau in individuals after nonconcussive head impacts. Objective To determine the association of repetitive low-intensity head impacts on p-tau 181 and total tau protein levels in the plasma of young adult elite soccer players and assess the possible association of head impacts with focused attention and cognitive flexibility. Design, Setting, and Participants In this cohort study, young elite soccer players performed intense physical activity with and without heading the ball. The study was conducted at a university facility in Slovakia from October 1, 2021, to May 31, 2022. Eligible participants were selected based on similarities in demographic variables, excluding those with a history of TBI. Main Outcomes and Measures The primary study outcomes were the levels of total tau protein and p-tau 181 in plasma samples and the cognitive status of the study participants. Results A total of 37 male athletes participated in the study (mean [SD] age: exercise group, 21.6 [1.6] years; heading group, 21.2 [1.5] years). We found significantly elevated levels of total tau and p-tau 181 in the plasma of soccer players 1 hour after physical exercise (tau, 1.4-fold; 95% CI, 1.2-1.5; P &amp;amp;lt; .001; p-tau 181 , 1.4-fold; 95% CI, 1.3-1.5, P &amp;amp;lt; .001) and repetitive head impacts (tau, 1.3-fold; 95% CI, 1.2-1.4; P &amp;amp;lt; .001; p-tau 181 , 1.5-fold; 95% CI, 1.4-1.7 P &amp;amp;lt; .001). The ratio of p-tau 181 to tau was significantly higher 1 hour after exercise and heading training, and remained elevated specifically in the heading group even after 24 hours (1.2-fold; 95% CI, 1.1-1.3; P = .002). Performance in cognitive tests revealed a significant decline in focused attention and cognitive flexibility after physical exercise and heading training; physical exercise of higher intensity without heading training was associated with a greater negative cognitive performance than heading only. Conclusions and Relevance In this cohort study of young elite soccer players, the elevation of p-tau 181 and tau was observed after acute intense physical activity and nonconcussive repetitive head impacts. The increase of p-tau 181 levels relative to tau after 24 hours indicated an acute enrichment of phosphorylated tau fraction in the periphery when compared with preimpact levels; an imbalance of tau proteins may have long-lasting consequences in the brain of head-impacted individuals.
Effect of the Memory Training for Recovery–Adolescent Intervention vs Treatment as Usual on Psychiatric Symptoms Among Adolescent Girls in Afghanistan
Authors: Sayed Jafar Ahmadi, Laura Jobson, Zeinab Musavi, Sayed Rohullah Rezwani, Farshad Ahmad Amini, Arul Earnest, Nasratullah Samim, Sayed Ali Akbar Sarwary, Sayed Abbas Sarwary, Daniel McAvoy
Journal: JAMA Network Open (2023)

Importance Adolescents who experience conflict in humanitarian contexts often have high levels of psychiatric distress but rarely have access to evidence-based interventions. Objective To investigate the efficacy of Memory Training for Recovery–Adolescent (METRA) intervention in improving psychiatric symptoms among adolescent girls in Afghanistan. Design, Setting, and Participants This randomized clinical trial included girls and young women aged 11 to 19 years with heightened psychiatric distress living in Kabul, Afghanistan, and was conducted as a parallel-group trial comparing METRA with treatment as usual (TAU), with a 3-month follow-up. Participants were randomized 2:1 to receive either METRA or TAU. The study occurred between November 2021 and March 2022 in Kabul. An intention-to-treat approach was used. Interventions Participants assigned to METRA received a 10-session group-intervention comprised of 2 modules (module 1: memory specificity; module 2: trauma writing). The TAU group received 10 group adolescent health sessions. Interventions were delivered over 2 weeks. Main Outcomes and Measures Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms after the intervention. Secondary outcomes were self-reported measures of anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties. Assessments occurred at baseline, after modules 1 and 2, and at 3 months after treatment. Results The 125 participants had a mean (SD) age of 15.96 (1.97) years. Overall sample size for primary analyses included 80 adolescents in the METRA group and 45 adolescents in TAU. Following the intention-to-treat principle, generalized estimating equations found that the METRA group had a 17.64-point decrease (95% CI, −20.38 to −14.91 points) in PTSD symptoms and a 6.73-point decrease (95% CI, −8.50 to −4.95 points) in depression symptoms, while the TAU group had a 3.34-point decrease (95% CI, −6.05 to −0.62 points) in PTSD symptoms and a 0.66-point increase (95% CI, −0.70 to 2.01 points) in depression symptoms, with the group × time interactions being significant (all P &amp;amp;lt; .001). METRA participants had significantly greater reductions in anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties than TAU participants. All improvements were maintained at 3-month follow-up. Dropout in the METRA group was 22.5% (18 participants) vs 8.9% for TAU (4 participants). Conclusions and Relevance In this randomized clinical trial, those in the METRA group had significantly greater improvements in psychiatric symptoms relative to those in the TAU group. METRA appeared to be a feasible and effective intervention for adolescents in humanitarian contexts. Trial Registration anzctr.org.au Identifier: ACTRN12621001160820
The European Guidelines on Diagnosis and Management of Neutropenia in Adults and Children: A Consensus Between the European Hematology Association and the EuNet-INNOCHRON COST Action
Authors: Francesca Fioredda, Julia Skokowa, Hannah Tamary, Michail Spanoudakis, Piero Farruggia, Antonio Almeida, Daniela Guardo, Petter Höglund, Peter E. Newburger, Jan Palmblad, Ivo P. Touw, Cornelia Zeidler, Alan J. Warren, David C. Dale, Karl Welte, Carlo Dufour, Helen A. Papadaki
Journal: HemaSphere (2023)

Neutropenia, as an isolated blood cell deficiency, is a feature of a wide spectrum of acquired or congenital, benign or premalignant disorders with a predisposition to develop myelodysplastic neoplasms/acute myeloid leukemia that may arise at any age. In recent years, advances in diagnostic methodologies, particularly in the field of genomics, have revealed novel genes and mechanisms responsible for etiology and disease evolution and opened new perspectives for tailored treatment. Despite the research and diagnostic advances in the field, real world evidence, arising from international neutropenia patient registries and scientific networks, has shown that the diagnosis and management of neutropenic patients is mostly based on the physicians’ experience and local practices. Therefore, experts participating in the European Network for the Innovative Diagnosis and Treatment of Chronic Neutropenias have collaborated under the auspices of the European Hematology Association to produce recommendations for the diagnosis and management of patients across the whole spectrum of chronic neutropenias. In the present article, we describe evidence- and consensus-based guidelines for the definition and classification, diagnosis, and follow-up of patients with chronic neutropenias including special entities such as pregnancy and the neonatal period. We particularly emphasize the importance of combining the clinical findings with classical and novel laboratory testing, and advanced germline and/or somatic mutational analyses, for the characterization, risk stratification, and monitoring of the entire spectrum of neutropenia patients. We believe that the wide clinical use of these practical recommendations will be particularly beneficial for patients, families, and treating physicians.
Pathologic Complete Response and Clinical Outcomes in Patients With Localized Soft Tissue Sarcoma Treated With Neoadjuvant Chemoradiotherapy or Radiotherapy
Authors: Dian Wang, Jonathan Harris, William G. Kraybill, Burt Eisenberg, David G. Kirsch, David S. Ettinger, John M. Kane, Parul N. Barry, Arash Naghavi, Carolyn R. Freeman, Yen-Lin Chen, Ying J. Hitchcock, Manpreet Bedi, Kilian E. Salerno, Diane Severin, Karen D. Godette, Nicole A. Larrier, Walter J. Curran, Pedro A. Torres-Saavedra, David R. Lucas
Journal: JAMA Oncology (2023)

Importance Pathologic complete response (pCR) may be associated with prognosis in patients with soft tissue sarcoma (STS). Objective We sought to determine the prognostic significance of pCR on survival outcomes in STS for patients receiving neoadjuvant chemoradiotherapy (CT-RT) (Radiation Therapy Oncology Group [RTOG] 9514) or preoperative image-guided radiotherapy alone (RT, RTOG 0630) and provide a long-term update of RTOG 0630. Design, Setting, and Participants RTOG has completed 2 multi-institutional, nonrandomized phase 2 clinical trials for patients with localized STS. One hundred forty-three eligible patients from RTOG 0630 (n = 79) and RTOG 9514 (n = 64) were included in this ancillary analysis of pCR and 79 patients from RTOG 0630 were evaluated for long-term outcomes. Intervention Patients in trial 9514 received CT interdigitated with RT, whereas those in trial 0630 received preoperative RT alone. Main Outcomes and Measures Overall and disease-free survival (OS and DFS) rates were estimated by the Kaplan-Meier method. Hazard ratios (HRs) and P values were estimated by multivariable Cox model stratified by study, where possible; otherwise, P values were calculated by stratified log-rank test. Analysis took place between December 14, 2016, to April 13, 2017. Results Overall there were 42 (53.2%) men; 68 (86.1%) were white; with a mean (SD) age of 59.6 (14.5) years. For RTOG 0630, at median follow-up of 6.0 years, there was 1 new in-field recurrence and 1 new distant failure since the initial report. From both studies, 123 patients were evaluable for pCR: 14 of 51 (27.5%) in trial 9514 and 14 of 72 (19.4%) in trial 0630 had pCR. Five-year OS was 100% for patients with pCR vs 76.5% (95% CI, 62.3%-90.8%) and 56.4% (95% CI, 43.3%-69.5%) for patients with less than pCR in trials 9514 and 0630, respectively. Overall, pCR was associated with improved OS ( P = .01) and DFS (HR, 4.91; 95% CI, 1.51-15.93; P = .008) relative to less than pCR. Five-year local failure rate was 0% in patients with pCR vs 11.7% (95% CI, 3.6%-25.1%) and 9.1% (95% CI, 3.3%-18.5%) for patients with less than pCR in 9514 and 0630, respectively. Histologic types other than leiomyosarcoma, liposarcoma, and myxofibrosarcoma were associated with worse OS (HR, 2.24; 95% CI, 1.12-4.45). Conclusions and Relevance This ancillary analysis of 2 nonrandomized clinical trials found that pCR was associated with improved survival in patients with STS and should be considered as a prognostic factor of clinical outcomes for future studies. Trial Registration ClinicalTrials.gov Identifiers: RTOG 0630 ( NCT00589121 ); RTOG 9514 ( NCT00002791 )
How to Estimate Kidney Growth in Patients with Autosomal Dominant Polycystic Kidney Disease
Authors: Francisco José Borrego Utiel, Mario Espinosa Hernández
Journal: Journal of the American Society of Nephrology (2023)

Autosomal dominant polycystic kidney disease (ADPKD) is a disease characterized by a progressive kidney growth due to the development of cysts that lead to gradual destruction of the surrounding parenchyma. In the first stage, the estimated GFR will remain stable despite the reduction of the renal parenchyma because of an increase in glomerular hyperfiltration. The total kidney volume (TKV) measured with computed tomography or magnetic resonance imaging is related to the future GFR decline. Thus, TKV has become an early marker to be analyzed in all patients with ADPKD. In addition, in recent years, it has been pointed out that kidney growth rate estimated with a single TKV measurement can be a clear prognostic marker for future glomerular filtration decline. However, there is no consensus on how to measure kidney volume growth in ADPKD, so each author has used different models that, not having the same meaning, have been handled as if they produced similar values. This may lead to erroneous estimates of kidney growth rate with the consequent prognostic error. The Mayo Clinic classification is now the most widely accepted prognostic model in clinical practice to predict patients who will deteriorate faster and to decide what patients should be treated with tolvaptan. However, some aspects of this model have not been discussed in depth. Our aim in this review was to present the models that can be used to estimate kidney volume growth rate in ADPKD, to facilitate their applicability in daily clinical practice.
Noninvasive Detection of iC3b/C3d Deposits in the Kidney Using a Novel Bioluminescent Imaging Probe
Authors: Brandon Renner, Felix Poppelaars, Jennifer Laskowski, Natalie J. Serkova, Liudmila Kulik, V. Michael Holers, Joshua M. Thurman
Journal: Journal of the American Society of Nephrology (2023)

Significance Statement Histologic quantification of complement C3 deposits in kidney biopsies provides prognostic information in patients with glomerulonephritis. Unfortunately, kidney biopsies are invasive procedures that cannot be performed regularly and only provide a snapshot of a small portion of one kidney at the time of sampling. We have developed a method to noninvasively detect specific C3 fragment deposition throughout both kidneys, using a monoclonal antibody targeting tissue-bound iC3b/C3d linked to a bioluminescent resonance energy transfer construct that emits near-infrared light. In a mouse model of glomerulonephritis, the probe detected iC3b/C3d in kidneys of live mice by bioluminescent imaging. This demonstrates that noninvasive imaging with an anti-iC3b/C3d probe can be used to monitor inflammation in the kidneys.
Effectiveness and Safety of Trabectedin and Radiotherapy for Patients With Myxoid Liposarcoma
Authors: Roberta Sanfilippo, Nadia Hindi, Josefina Cruz Jurado, Jean-Yves Blay, Antonio Lopez-Pousa, Antoine Italiano, Rosa Alvarez, Antonio Gutierrez, Inmaculada Rincón-Perez, Claudia Sangalli, Jose Luis Pérez Aguiar, Jesús Romero, Carlo Morosi, Marie-Pierre Sunyach, Chiara Fabbroni, Cleofe Romagosa, Dominique Ranchere-Vince, Angelo P. Dei Tos, Paolo G. Casali, Javier Martin-Broto, Alessandro Gronchi
Journal: JAMA Oncology (2023)

Preclinical data about the synergistic activity of radiotherapy (RT) and trabectedin have been reported. The combination of trabectedin and RT in treating myxoid liposarcomas appears worth exploring.
Laparoscopic vs Open Surgery for Low Rectal Cancer
Authors: Tao Yuan, Qin Ma, Ming-Ming Zhang
Journal: JAMA Oncology (2023)

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Safe Listening at Venues and Events with Amplified Music — United States, 2022
Authors: John Eichwald, Christa L. Themann, Franco Scinicariello
Journal: MMWR Morbidity and Mortality Weekly Report (2023)

Nearly one in four (24.4%) U.S. adults aged 20-69 years show evidence of noise-induced hearing loss (1). Among those reporting exposure to noise outside of work, 19.9% showed possible noise-induced hearing loss. Exposure to non-job-related noise can be substantial (2). Loud music from personal listening devices and entertainment venues might place more than 1 billion teenagers and young adults at risk for hearing loss worldwide (3). Early noise exposure might increase the risk for age-related hearing loss later in life (4). CDC analyzed data from the 2022 FallStyles survey (conducted by Porter Novelli via the Ipsos' KnowledgePanel) on U.S. adult perceptions regarding preventing hearing loss from amplified music at venues or events. More than one half of U.S. adults agreed with one or more of the following protective actions: limiting sound levels, posting warning signs, and using hearing protection when music at such events reaches potentially hazardous levels. Hearing and other health professionals can make use of existing materials available from the World Health Organization (WHO), CDC, and other professional organizations to raise awareness about noise risks and promote protective behaviors.
Emergency Department Visits for Firearm Injuries Before and During the COVID-19 Pandemic — United States, January 2019–December 2022
Authors: Marissa L. Zwald, Miriam E. Van Dyke, May S. Chen, Lakshmi Radhakrishnan, Kristin M. Holland, Thomas R. Simon, Linda L. Dahlberg, Norah W. Friar, Michael Sheppard, Aaron Kite-Powell, James A. Mercy
Journal: MMWR Morbidity and Mortality Weekly Report (2023)

During the COVID-19 pandemic, the U.S. firearm homicide rate increased by nearly 35%, and the firearm suicide rate remained high during 2019-2020 (1). Provisional mortality data from the National Vital Statistics System indicate that rates continued to increase in 2021: the rates of firearm homicide and firearm suicide in 2021 were the highest recorded since 1993 and 1990, respectively (2). Firearm injuries treated in emergency departments (EDs), the primary setting for the immediate medical treatment of such injuries, gradually increased during 2018-2019 (3); however, more recent patterns of ED visits for firearm injuries, particularly during the COVID-19 pandemic, are unknown. Using data from the National Syndromic Surveillance Program (NSSP),* CDC examined changes in ED visits for initial firearm injury encounters during January 2019-December 2022, by year, patient sex, and age group. Increases in the overall weekly number of firearm injury ED visits were detected at certain periods during the COVID-19 pandemic. One such period during which there was a gradual increase was March 2020, which coincided with both the declaration of COVID-19 as a national emergency† and a pronounced decrease in the total number of ED visits. Another increase in firearm injury ED visits occurred in late May 2020, concurrent with a period marked by public outcry related to social injustice and structural racism (4), changes in state-level COVID-19-specific prevention strategies,§ decreased engagement in COVID-19 mitigation behaviors (5), and reported increases in some types of crime (4). Compared with 2019, the average number of weekly ED visits for firearm injury was 37% higher in 2020, 36% higher in 2021, and 20% higher in 2022. A comprehensive approach is needed to prevent and respond to firearm injuries in communities, including strategies that engage community and street outreach programs, implement hospital-based violence prevention programs, improve community physical environments, enhance secure storage of firearms, and strengthen social and economic supports.